Pulmonary Arteriovenous Malformation (PAVM)
Pulmonary arteriovenous malformation (PAVM) is a condition that affects blood vessels in the lungs. Affected people have an abnormal direct connections between the pulmonary vein (the vessel that carries blood from the lungs to the heart) and pulmonary artery (carries blood from the heart to the lungs). As a result, two problems arise. Blood may not be properly oxygenated by the lungs and debris and particles do not get filtered across the connections and are directly passed into the blood vessels of multiple organs like brain leading to infections in such organs. Some even get hyperdynamic circulation leading to great stress on the heart. It may even be incidentally detected in a few affected people who may have no signs or symptoms of the condition at the time of diagnosis. When present, symptoms may include difficulty breathing, shortness of breath, difficulty exercising, blue skin and even symptoms due to brain infection.
Diagnostic methods
Diagnosis is based on imaging demonstrating one or more AVMs usually located in the lower lobes of the lungs. Although PAVMs may be clearly visible on chest x-rays, many are not, even when clinically significant. Computed tomography (CT) angiography is generally considered the gold-standard investigation for diagnosing PAVMs. AVMs can be isolated or multiple, unilateral (in one lung) or bilateral (both lungs).
Management and treatment
Percutaneous transcatheter embolization of the pulmonary artery/ies feeding the PAVMs is the treatment of choice, irrespective of respiratory symptoms. It is a minimally invasive option carried out by a small puncture in the right groin (in the same way a cardiac angiography is done). The procedure offers a very high success rate with minimal chances of recurrence and very fast recovery. Additional ancillary/ supportive recommendations include judicious dental hygiene; antibiotic prophylaxis prior to dental and surgical procedures; optimization of iron status; and pregnancy-specific recommendations.